Healthcare Provider Details

I. General information

NPI: 1427596170
Provider Name (Legal Business Name): CYNTHIA QUALEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOULTON ST
PATTEN ME
04765-3035
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2285
  • Fax: 207-528-2880
Mailing address:
  • Phone: 207-528-2285
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH953
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: